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Hepatitis cases are increasing among children in the UK – could COVID have a role to play?

While COVID-19 hasn’t been ruled out as a potential cause, the leading contender is actually adenovirus, a common infection in children that can lead…

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There has been a sharp increase in severe hepatitis cases among children under ten in the UK over recent months. The UK Health Security Agency has been informed of 74 cases since January 2022, with 49 of these in England, 13 in Scotland and the remaining 12 spread between Wales and Northern Ireland.

Other isolated cases of severe acute hepatitis in children have been identified in the US, Spain and Ireland.

Severe hepatitis in children is very rare and we don’t yet know what’s causing this highly unusual rise in cases. The leading theory is that it’s some kind of viral infection, perhaps even SARS-CoV-2, the coronavirus that causes COVID-19.

But how likely is it that these hepatitis cases are linked to COVID? Or is there a more likely cause to be found elsewhere?

First let’s break down what hepatitis is and how it’s linked to viral infections.

Hepatitis is the medical term for inflammation of the liver. Inflammation is a general immune response to an infection or injury – a sign the body is trying to fight off a potential disease. Symptoms in children usually include some (but not all) of the following: dark urine, grey-coloured faeces, yellowing of the skin and eyes (called jaundice) and a high temperature.

With the right medical attention the condition can usually be treated, but some patients may require a liver transplant. The World Health Organization has reported that six of the children affected in the UK have undergone a transplant so far.


Read more: With all the focus on coronavirus, let's not forget the other respiratory viruses


The causes can be varied but in children, hepatitis is usually associated with viral infections. The most common of these are the five hepatitis viruses: hepatitis A, B, C, D and E. Other viruses such as adenoviruses can cause hepatitis, but this is rare.

What is unusual about these cases in children is that none of the five hepatitis viruses have been detected in any of the patients. This rules out the most common cause of these symptoms, leaving public health authorities searching for answers.

Adenoviruses and hepatitis

Adenoviruses are a very common viral infection in humans, especially children. Nearly every child has at least one adenovirus infection before the age of ten.

Usually, these viruses cause infections of the lungs and airways, resulting in common cold symptoms and sometimes pneumonia. In some cases, mostly in children aged five and over, adenoviruses can cause what’s sometimes referred to as “pool fever”, resulting in a sore throat, fever and inflammation of the eyes.

In immunocompromised patients (anybody with an immune system that’s not functioning properly, such as those undergoing organ transplants or cancer treatments), adenoviruses can on rare occasions cause hepatitis.

But to see it on this scale is extremely rare, especially in children who don’t appear to be immunocompromised. If adenovirus is the cause of these cases, it could mean that a new variant of adenovirus has emerged that more easily causes hepatitis.

An illustration of the hepatitis virus surrounding the liver.
Hepatitis refers to inflammation of the liver. Explode/Shutterstock

Other potential causes

Adenovirus seems to be the most likely explanation, as it’s a common infection in children and can cause hepatitis. But there are some alternative scenarios that should be explored.

Autoimmune hepatitis, where the body itself attacks the liver (as opposed to a virus or other pathogen attacking it), could potentially cause such cases. But this is a rare condition, affecting roughly 10,000 people in the UK and usually found in women around the age of 45. With these things in mind, autoimmune hepatitis is very unlikely to be the cause of a cluster of cases in children.

There have been suggestions that COVID could be behind these cases of hepatitis, as SARS-CoV-2 has been detected in some of the children. Isolated cases of hepatitis have been reported in COVID patients, but this is even rarer than autoimmune hepatitis, and has mostly been observed in adults with severe COVID.

Importantly, none of the children diagnosed with hepatitis in the UK have received a COVID vaccination, so there’s no basis to believe COVID vaccines have anything to do with this spike.

Another possibility is that this is a new symptom resulting from interaction between viruses (perhaps adenovirus and coronavirus both infecting the same child, for example). Alternatively, it could be caused by a totally different virus that hasn’t been detected yet.

What now?

The UK Health Security Agency is advising parents and carers to be alert to signs of hepatitis in children.

While adenovirus currently looks to be the most likely cause here, further investigation will be needed to confirm this, and rule out other possible explanations such as novel viruses. It may even turn out that the cause is not common among all cases.

As the COVID pandemic continues, we must routinely consider coronavirus as a possible cause for unusual healthcare scenarios. At the same time, we shouldn’t assume there’s always necessarily a link. Such thinking carries the risk of blinding us to what’s really going on.


Read more: We have a good chance of curing the common cold in next ten years – a scientist explains


If adenovirus is found to be the main cause, what can we do to protect against it, and in turn minimise any risk of serious complications? Adenoviruses spread through the air and via touch. The main preventative measure is proper handwashing – by kids and adults alike – along with good respiratory hygiene, such as coughing into your elbow.

Conor Meehan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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There will soon be one million seats on this popular Amtrak route

“More people are taking the train than ever before,” says Amtrak’s Executive Vice President.

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While the size of the United States makes it hard for it to compete with the inter-city train access available in places like Japan and many European countries, Amtrak trains are a very popular transportation option in certain pockets of the country — so much so that the country’s national railway company is expanding its Northeast Corridor by more than one million seats.

Related: This is what it's like to take a 19-hour train from New York to Chicago

Running from Boston all the way south to Washington, D.C., the route is one of the most popular as it passes through the most densely populated part of the country and serves as a commuter train for those who need to go between East Coast cities such as New York and Philadelphia for business.

Veronika Bondarenko captured this photo of New York’s Moynihan Train Hall. 

Veronika Bondarenko

Amtrak launches new routes, promises travelers ‘additional travel options’

Earlier this month, Amtrak announced that it was adding four additional Northeastern routes to its schedule — two more routes between New York’s Penn Station and Union Station in Washington, D.C. on the weekend, a new early-morning weekday route between New York and Philadelphia’s William H. Gray III 30th Street Station and a weekend route between Philadelphia and Boston’s South Station.

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According to Amtrak, these additions will increase Northeast Corridor’s service by 20% on the weekdays and 10% on the weekends for a total of one million additional seats when counted by how many will ride the corridor over the year.

“More people are taking the train than ever before and we’re proud to offer our customers additional travel options when they ride with us on the Northeast Regional,” Amtrak Executive Vice President and Chief Commercial Officer Eliot Hamlisch said in a statement on the new routes. “The Northeast Regional gets you where you want to go comfortably, conveniently and sustainably as you breeze past traffic on I-95 for a more enjoyable travel experience.”

Here are some of the other Amtrak changes you can expect to see

Amtrak also said that, in the 2023 financial year, the Northeast Corridor had nearly 9.2 million riders — 8% more than it had pre-pandemic and a 29% increase from 2022. The higher demand, particularly during both off-peak hours and the time when many business travelers use to get to work, is pushing Amtrak to invest into this corridor in particular.

To reach more customers, Amtrak has also made several changes to both its routes and pricing system. In the fall of 2023, it introduced a type of new “Night Owl Fare” — if traveling during very late or very early hours, one can go between cities like New York and Philadelphia or Philadelphia and Washington. D.C. for $5 to $15.

As travel on the same routes during peak hours can reach as much as $300, this was a deliberate move to reach those who have the flexibility of time and might have otherwise preferred more affordable methods of transportation such as the bus. After seeing strong uptake, Amtrak added this type of fare to more Boston routes.

The largest distances, such as the ones between Boston and New York or New York and Washington, are available at the lowest rate for $20.

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The next pandemic? It’s already here for Earth’s wildlife

Bird flu is decimating species already threatened by climate change and habitat loss.

I am a conservation biologist who studies emerging infectious diseases. When people ask me what I think the next pandemic will be I often say that we are in the midst of one – it’s just afflicting a great many species more than ours.

I am referring to the highly pathogenic strain of avian influenza H5N1 (HPAI H5N1), otherwise known as bird flu, which has killed millions of birds and unknown numbers of mammals, particularly during the past three years.

This is the strain that emerged in domestic geese in China in 1997 and quickly jumped to humans in south-east Asia with a mortality rate of around 40-50%. My research group encountered the virus when it killed a mammal, an endangered Owston’s palm civet, in a captive breeding programme in Cuc Phuong National Park Vietnam in 2005.

How these animals caught bird flu was never confirmed. Their diet is mainly earthworms, so they had not been infected by eating diseased poultry like many captive tigers in the region.

This discovery prompted us to collate all confirmed reports of fatal infection with bird flu to assess just how broad a threat to wildlife this virus might pose.

This is how a newly discovered virus in Chinese poultry came to threaten so much of the world’s biodiversity.

H5N1 originated on a Chinese poultry farm in 1997. ChameleonsEye/Shutterstock

The first signs

Until December 2005, most confirmed infections had been found in a few zoos and rescue centres in Thailand and Cambodia. Our analysis in 2006 showed that nearly half (48%) of all the different groups of birds (known to taxonomists as “orders”) contained a species in which a fatal infection of bird flu had been reported. These 13 orders comprised 84% of all bird species.

We reasoned 20 years ago that the strains of H5N1 circulating were probably highly pathogenic to all bird orders. We also showed that the list of confirmed infected species included those that were globally threatened and that important habitats, such as Vietnam’s Mekong delta, lay close to reported poultry outbreaks.

Mammals known to be susceptible to bird flu during the early 2000s included primates, rodents, pigs and rabbits. Large carnivores such as Bengal tigers and clouded leopards were reported to have been killed, as well as domestic cats.

Our 2006 paper showed the ease with which this virus crossed species barriers and suggested it might one day produce a pandemic-scale threat to global biodiversity.

Unfortunately, our warnings were correct.

A roving sickness

Two decades on, bird flu is killing species from the high Arctic to mainland Antarctica.

In the past couple of years, bird flu has spread rapidly across Europe and infiltrated North and South America, killing millions of poultry and a variety of bird and mammal species. A recent paper found that 26 countries have reported at least 48 mammal species that have died from the virus since 2020, when the latest increase in reported infections started.

Not even the ocean is safe. Since 2020, 13 species of aquatic mammal have succumbed, including American sea lions, porpoises and dolphins, often dying in their thousands in South America. A wide range of scavenging and predatory mammals that live on land are now also confirmed to be susceptible, including mountain lions, lynx, brown, black and polar bears.

The UK alone has lost over 75% of its great skuas and seen a 25% decline in northern gannets. Recent declines in sandwich terns (35%) and common terns (42%) were also largely driven by the virus.

Scientists haven’t managed to completely sequence the virus in all affected species. Research and continuous surveillance could tell us how adaptable it ultimately becomes, and whether it can jump to even more species. We know it can already infect humans – one or more genetic mutations may make it more infectious.

At the crossroads

Between January 1 2003 and December 21 2023, 882 cases of human infection with the H5N1 virus were reported from 23 countries, of which 461 (52%) were fatal.

Of these fatal cases, more than half were in Vietnam, China, Cambodia and Laos. Poultry-to-human infections were first recorded in Cambodia in December 2003. Intermittent cases were reported until 2014, followed by a gap until 2023, yielding 41 deaths from 64 cases. The subtype of H5N1 virus responsible has been detected in poultry in Cambodia since 2014. In the early 2000s, the H5N1 virus circulating had a high human mortality rate, so it is worrying that we are now starting to see people dying after contact with poultry again.

It’s not just H5 subtypes of bird flu that concern humans. The H10N1 virus was originally isolated from wild birds in South Korea, but has also been reported in samples from China and Mongolia.

Recent research found that these particular virus subtypes may be able to jump to humans after they were found to be pathogenic in laboratory mice and ferrets. The first person who was confirmed to be infected with H10N5 died in China on January 27 2024, but this patient was also suffering from seasonal flu (H3N2). They had been exposed to live poultry which also tested positive for H10N5.

Species already threatened with extinction are among those which have died due to bird flu in the past three years. The first deaths from the virus in mainland Antarctica have just been confirmed in skuas, highlighting a looming threat to penguin colonies whose eggs and chicks skuas prey on. Humboldt penguins have already been killed by the virus in Chile.

A colony of king penguins.
Remote penguin colonies are already threatened by climate change. AndreAnita/Shutterstock

How can we stem this tsunami of H5N1 and other avian influenzas? Completely overhaul poultry production on a global scale. Make farms self-sufficient in rearing eggs and chicks instead of exporting them internationally. The trend towards megafarms containing over a million birds must be stopped in its tracks.

To prevent the worst outcomes for this virus, we must revisit its primary source: the incubator of intensive poultry farms.

Diana Bell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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This is the biggest money mistake you’re making during travel

A retail expert talks of some common money mistakes travelers make on their trips.

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Travel is expensive. Despite the explosion of travel demand in the two years since the world opened up from the pandemic, survey after survey shows that financial reasons are the biggest factor keeping some from taking their desired trips.

Airfare, accommodation as well as food and entertainment during the trip have all outpaced inflation over the last four years.

Related: This is why we're still spending an insane amount of money on travel

But while there are multiple tricks and “travel hacks” for finding cheaper plane tickets and accommodation, the biggest financial mistake that leads to blown travel budgets is much smaller and more insidious.

A traveler watches a plane takeoff at an airport gate.

Jeshoots on Unsplash

This is what you should (and shouldn’t) spend your money on while abroad

“When it comes to traveling, it's hard to resist buying items so you can have a piece of that memory at home,” Kristen Gall, a retail expert who heads the financial planning section at points-back platform Rakuten, told Travel + Leisure in an interview. “However, it's important to remember that you don't need every souvenir that catches your eye.”

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According to Gall, souvenirs not only have a tendency to add up in price but also weight which can in turn require one to pay for extra weight or even another suitcase at the airport — over the last two months, airlines like Delta  (DAL) , American Airlines  (AAL)  and JetBlue Airways  (JBLU)  have all followed each other in increasing baggage prices to in some cases as much as $60 for a first bag and $100 for a second one.

While such extras may not seem like a lot compared to the thousands one might have spent on the hotel and ticket, they all have what is sometimes known as a “coffee” or “takeout effect” in which small expenses can lead one to overspend by a large amount.

‘Save up for one special thing rather than a bunch of trinkets…’

“When traveling abroad, I recommend only purchasing items that you can't get back at home, or that are small enough to not impact your luggage weight,” Gall said. “If you’re set on bringing home a souvenir, save up for one special thing, rather than wasting your money on a bunch of trinkets you may not think twice about once you return home.”

Along with the immediate costs, there is also the risk of purchasing things that go to waste when returning home from an international vacation. Alcohol is subject to airlines’ liquid rules while certain types of foods, particularly meat and other animal products, can be confiscated by customs. 

While one incident of losing an expensive bottle of liquor or cheese brought back from a country like France will often make travelers forever careful, those who travel internationally less frequently will often be unaware of specific rules and be forced to part with something they spent money on at the airport.

“It's important to keep in mind that you're going to have to travel back with everything you purchased,” Gall continued. “[…] Be careful when buying food or wine, as it may not make it through customs. Foods like chocolate are typically fine, but items like meat and produce are likely prohibited to come back into the country.

Related: Veteran fund manager picks favorite stocks for 2024

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